Double Vision (Diplopia): Causes, Symptoms, Diagnosis, and Treatment Weakness in your eyes or anywhere else Droopy eyelids How Is It Diagnosed? Double vision that's new or unexplained needs medical care right away. With so many potential causes, it's important to discover the reason without delay. Your doctor will most likely use more than one method to find out what’s causing your problem. He might try blood tests, a physical exam , and maybe an imaging test like computed tomography (CT) or magnetic resonance imaging (MRI). One of the most effective tools for your doctor is the information you provide. Think about these questions before your appointment. When did the double vision start? Have you hit your head, fallen, or been unconscious? Were you in a car accident? Is the double vision worse at the end of the day or when you're tired? Have you had any other symptoms besides double vision? Do you tend to tilt your head to one side? Look at old pictures, or ask family -- you may not even be aware of the habit. Now, focus on something in your field of vision that isn’t moving, like a window or a tree.

Are the two objects side by side, or is one on top of the other? Or are they slightly slanted? Which one is higher or lower? Are both images clear but not in line? Or is one blurry and the other clear? Cover one eye, then switch. Does the problem go away when either eye is covered? Pretend your field of vision is a clock face. Move your eyes around the clock, from noon to six and around to 12 again. Is your vision worse at any clock position? Does any position make it better? Tilt your head to the right, then to the left. Do any of these positions improve your eyesight or make it worse? Continued Diplopia | definition of diplopia by Medical dictionary Diplopia | definition of diplopia by Medical dictionary [dĭ-plo´pe-ah] the perception of two images of a single object; called also double vision . binocular diplopia double vision in which the images of an object are formed on noncorresponding points of the retinas.

crossed diplopia horizontal diplopia in which the image belonging to the right eye is displaced to the left of the image belonging to the left eye (divergent strabismus). direct diplopia horizontal diplopia in which the image belonging to the right eye appears to the right of the image belonging to the left eye (convergent strabismus). horizontal diplopia diplopia in which the two images lie in the same horizontal plane, being either direct or crossed. vertical diplopia diplopia in which one image appears above the other in the same vertical plane. di·plo·pi·a diplopia /di·plo·pia/ (dĭ-plo´pe-ah) the perception of two images of a single object. binocular diplopia double vision in which the images of an object are formed on noncorresponding points of the retinas. crossed diplopia diplopia in which the image belonging to the right eye is displaced to the left of the image belonging to the left eye. direct diplopia that in which the image belonging to the right eye appears to the right of the image belonging to the left eye.

homonymous diplopia direct d. horizontal diplopia that in which the images lie in the same horizontal plane, being either direct or crossed. monocular diplopia perception by one eye of two images of a single object. paradoxical diplopia crossed d. torsional diplopia that in which the upper pole of the vertical axis of one image is inclined toward or away from that of the other. vertical diplopia that in which one image appears above the other in the same vertical plane. diplopia di·plo′pic (-plō′pĭk, dĭ-plŏp′ĭk) adj. diplopia [diplō′pē·ə] Etymology: Gk, diploos + opsis, vision double vision caused by defective function of the extraocular muscles or a disorder of the nerves that innervate the muscles. It occurs when the object of fixation falls on the fovea in one eye and a nonfoveal point in the other eye or when the object of fixation falls on two noncorresponding points. Also called ambiopia . Compare binocular vision .

diplopia Double vision Ophthalmology A condition whereby a single object appears as 2 di·plo·pi·a [G. diplous, double + G. ōps, eye] diplopia Double vision. The perception of two images of a single object. This occurs in squint (strabismus) when both eyes are not aligned on the object of interest. Diplopia with one eye is rare but possible. Diplopia Mentioned in: Nasal Trauma diplopia The condition in which a single object is seen as two rather than one. This is usually due to images not stimulating corresponding retinal areas. Other causes are given below. Syn. double vision (colloquial). See differential prismatic effect; haplopia ; myasthenia gravis ; retinal corresponding points ; polyopia ; multiple sclerosis ; strabismus ; diplopia test; triplopia . binocular diplopia Diplopia in which one image is seen by one eye and the other image is seen by the other eye. crossed diplopia See heteronymous diplopia .

heteronymous diplopia Binocular diplopia in which the image received by the right eye appears to the left and that received by the left eye appears to the right. In this condition the images are formed on the temporal retina. Syn. crossed diplopia. homonymous diplopia Binocular diplopia in which the image received by the right eye appears to the right and that received by the left eye appears to the left. In this condition, the images are formed on the nasal retina. Syn. uncrossed diplopia. incongruous diplopia Diplopia present in individuals with abnormal retinal correspondence in which the relative positions of the two images differ from what would be expected on the basis of normal retinal correspondence. Example: an exotrope experiencing homonymous diplopia instead of heteronymous diplopia. Syn. paradoxical diplopia. See abnormal retinal correspondence . monocular diplopia Diplopia seen by one eye only. It is usually caused by irregular refraction in one eye (e.g. in early cataracts, corneal opacity) or by dicoria or polycoria. It may be induced by placing a biprism in front of one eye.

See ghost image ; luxation of the lens . paradoxical diplopia See incongruous diplopia . pathological diplopia Any diplopia due to an eye disease (e.g. proptosis), an anomaly of binocular vision (e.g. strabismus), a variation in the refractive index of the media of the eye (e.g. cataract), a subluxation of the crystalline lens, or to a general disease (e.g. multiple sclerosis, myasthenia gravis). See exophthalmos ; luxation of the lens . physiological diplopia Normal phenomenon which occurs in binocular vision for non-fixated objects whose images fall on disparate retinal points. It is easily demonstrated to persons with normal binocular vision: fixate binocularly a distant object and place a pencil vertically some 25 cm in front of your nose. You should see two rather blurred pencils. The observation of physiological diplopia has been found to be useful in the management of eso or exo deviations, suppression, abnormal retinal correspondence, etc. (Fig. D4). See Brock string; retinal disparity . diplopia test See diplopia test.

uncrossed diplopia See homonymous diplopia . Fig. D4 Physiological diplopia. The subject fixates a distant object A di·plo·pi·a [G. diplous, double + G. ōps, eye] diplopia (diplō´pēə), n seeing a single object as two images. May occur after fracture of the bony orbital cavity as a result of displacement of the globe of the eye inferiorly. diplopia seeing two images; double vision. Patient discussion about diplopia Q. what is the cause for double vision A. Double vision, or diplopia, as it's called, may be due to many conditions, including disorders of the muscles of the eye (extra-ocular muscles) and the nerves controlling them, disorders of the eye ball (enlarged eyeball as in Graves' ), and sometimes disorders of vision. Diplopia may manifest important conditions, so consulting a doctor (e.g. neurologist or ophthalmologist) may be wise.

You may read more here: Diplopia Definition - Double Vision Double Vision By Troy Bedinghaus, OD Updated April 10, 2016 Are you seeing double? Double vision is the simultaneous perception of two images of a single object. The images may be displaced horizontally, vertically, diagonally, or rotationally in relation to each other. What is double vision? Double vision usually occurs when the eyes are misaligned, or not pointed at the same object, causing us to see two different images. Both images are sent to the brain which we process as double vision. Most of the time, both of our eyes are pointed at the same object. This produces a clear, single image with just enough difference between the two images to give us a slightly different line of sight. This subtle difference gives us depth perception , often referred to as stereo vision. In fact, the farther apart an animals eyes are, the better depth perception it has. Double vision can cause problems in life, including great difficulty in completing simple tasks. Luckily, the brain naturally guards against double vision by suppressing, or ignoring, one of the two images. We have a complex set of eye muscles and nerves that communicate with each other to keep both eyes moving along together.

Causes of Double Vision The medical term for double vision is diplopia. Diplopia can be intermittent or constant. Because the pathway for the three main nerves that control eye muscle movement is long, complex and originates in the brain, double vision can be a sign of a serious neurological problem. A defect anywhere along these pathways can possibly cause double vision. Some defects are caused by an injury to the head, stroke, aneurysm, brain tumor or brain swelling. Diabetes, hypertension and multiple sclerosis are common diseases that can cause a temporary paralysis of the nerves that control the eye muscles, which may cause double vision. Another cause of double vision is strabismus . Strabismus is a condition that causes the eyes to be misaligned, often referred to as an "eye turn." Most people with strabismus are born with it and have an eye that tends to move inward or outward. Strabismus can also cause one eye to be pointed up or down. In many infants, it is difficult to find a true cause. Sometimes strabismus is caused by a large refractive error (need for prescription glasses) and sometimes eye tumors.

Most young children do not suffer from double vision even though their eyes are misaligned. Our brain often compensates and prevents us from seeing double by suppressing one of the images and making it disappear. Our brain learns to ignore the extra image, known as suppression. Children seem to adapt quickly and their brains suppress one of the images quickly. However, when one image is suppressed, a child is at risk for developing amblyopia, often referred to as lazy eye, because the eye is not being used properly. When strabismus develops in adults, double vision is more likely to occur. An adult brain has difficulty suppression one image at first because for a large part of their life, both eyes were functioning to their fullest potential. Monocular Diplopia For the most part, you must have two fully functioning eyes to experience double vision. However, there is one type of double vision that can occur in one eye, called monocular diplopia. The most common cause of monocular diplopia is a cataract . A cataract is a clouding and opacification of the normally, clear lens inside the human eye. Most cataracts develop as we age. Some cataracts can be caused by trauma to the eye.

Occasionally, the clouding occurs in sharp junctions in the lens which causes light to split into two when it enters the eyes. Some individuals perceive that as double vision. Astigmatism can also cause double vision out of one eye. Astigmatism , a common vision problem that distorts vision, can sometimes elongate or stretch out an image so much that it appears to be double. Treatment of Double Vision Cover It - The simplest form of treatment of double vision is to cover one eye with a patch. This quickly eliminates one image but has the negative side effect of decreasing your dimensional vision or depth perception. Fresnel “Press-on” Prism - Another useful way of treating double vision is to apply a Fresnel prism on top of your eyeglasses. Fresnel prism is a thin sheet of many little prisms that shift light in a certain direction. The prism moves the image that the misaligned eye is seeing into a position so that both eyes can fuse the image into a single, clear image. Fresnel prism has the advantage of being temporary. The fresnel prism can be peeled off of the glasses easily as the diplopia resolves itself. Fresnel prism is useful when double vision is caused by conditions such as diabetes or hypertension.

Most often, the double vision lasts less than 6-9 months and then goes away when the underlying systemic condition is being treated. Ophthalmic Prism - If double vision is more permanent, then regular, ophthalmic prism can be ground into your eyeglass prescription. It occasionally increases the thickness of the lens on one side but is better looking cosmetically than a Fresnel prism. Vision Therapy - Vision Therapy (VT) encompasses a lot of different techniques to correct double vision and strabismus. Sometimes certain machines and computer models are used to give the person behavioral feedback to control the double vision. Other times, specific eye muscle exercises are done to strengthen the eye muscles. Surgery - Surgery for double vision is very successful in most cases. Eye surgeons who specialize in eye muscle surgery use a variety of techniques that involve shortening or moving eye muscles. Adjustable sutures are used to fine tune the eye muscle correction directly after surgery. Botox - Botulinum toxin is injected directly into one of the muscles controlling eye movement. This temporarily blocks the nerve impulse and causes the muscle to be paralyzed. This muscle relaxes and the other eye muscles take up the slack to straighten the eye.

Side effects including a droopy eyelid or worsened double vision. What You Should Know Double vision is a serious health concern. However “sudden onset” double vision is of special concern. When diplopia comes on suddenly, a neurological problem in your brain should always be ruled out before investigating more common causes. If you are experiencing double vision, you should be evaluated by an optometrist, ophthalmologist , neurologist or other medical professional immediately. Upon evaluation, your doctor will ask you the following questions: Did the double vision appear suddenly, or has it been there for some time? Is it constant, or does it seem to come and go? Does the double vision go away when you cover one eye? Do you see double out of one eye, or both eyes? Source: Neuro-Ophthalmology - Textbook of Ophthalmology. Slamovits, Thomas L. and Ronald Burd. Copyright 1994, Mosby-Year Book Europe, Ltd. Continue Reading Definition of Diplopia Our Double Vision Main Article provides a comprehensive look at the who, what, when and how of Double Vision Definition of Diplopia Diplopia: A condition in which a single object appears as two objects.

Also known as double vision . Last Editorial Review: 5/13/2016 Use the pill finder tool on RxList. Suggested Reading on Double Vision by Our Doctors Related Diseases & Conditions Get the latest health and medical information delivered direct to your inbox! Trending on MedicineNet Get the Latest health and medical information delivered direct to your inbox! From ©1996-2017 MedicineNet, Inc. All rights reserved. Terms of Use. MedicineNet does not provide medical advice, diagnosis or treatment. See additional information . Health Categories Double vision (diplopia): Causes, symptoms, diagnosis and treatment Select An Article Double vision (diplopia) When a person experiences double vision , or diplopia, they see two images of the same thing at the same time. Double vision may be a long-term problem, or the symptoms may come and go. Double vision may affect a person's ability to drive safely and the DVLA may need to be told about the condition. What causes diplopia or double vision? Opening your eyes and seeing a single clear image is something you probably take for granted. But that seemingly automatic process depends on the orchestration of multiple areas of the vision system.

They all need to work together seamlessly: The cornea is the clear outermost disc covering the eye . It allows in light. The lens is behind the pupil. It focuses light onto the retina. Muscles of the eye, called extraocular muscles, perform the eye's precise movements. Nerves carry visual information from the eyes to the brain . The brain is where several areas process visual information from the eyes. Problems with any part of the vision system can lead to diplopia. It makes sense to consider the causes of diplopia according to the part of the visual system that has the problem. Cornea problems. Problems with the cornea often cause double vision in one eye only. Covering the affected eye makes the diplopia go away. The damaged surface of the eye distorts incoming light, causing double vision . Damage can happen in several ways: Infections of the cornea, such as shingles ( herpes zoster), can distort the cornea. An uncommon complication of LASIK surgery ( laser eye surgery ) can leave one cornea altered, creating unequal visual images. Lens problems. Cataracts are the most common problem with the lens that causes double vision.

If cataracts are present in both eyes, images from both eyes will be distorted. Cataracts are often correctable with surgery. Muscle problems. If a muscle in one eye is weak, that eye can't move smoothly with the healthy eye. Gazing in directions controlled by the weak muscle causes double vision. Muscle problems can result from several causes: Myasthenia gravis is an autoimmune condition that blocks the stimulation of muscles by nerves inside the head. The earliest signs are often double vision and drooping eyelids (ptosis). Graves' disease is a thyroid condition that weakens the muscles of the eyes. Graves' disease commonly causes vertical diplopia. With vertical diplopia, one image is on top of the other. Nerve problems. Several different conditions can damage the nerves and lead to double vision: Multiple sclerosis can affect nerves anywhere in the brain or spinal cord. If the nerves controlling the eyes are damaged, double vision can result. Guillain-Barre syndrome is a nerve condition that causes progressive weakness . Sometimes, the first symptoms occur in the eyes and cause double vision. Uncontrolled diabetes can lead to nerve damage in one of the eyes, causing eye weakness and diplopia. Brain problems.

The nerves controlling the eyes connect directly to the brain. Further visual processing takes place inside the brain. Many different causes for diplopia originate in the brain. They include: Strokes Double Vision (Diplopia): Causes, Symptoms, and Treatments - Medical News Today Double Vision (Diplopia): Causes, Symptoms, and Treatments Written by Tim Newman Reviewed by University of Illinois-Chicago, School of Medicine 3.5 20 When an individual sees a double image where there should only be one, it is referred to as double vision or diplopia. The two images can be side by side, one on top of the other, or a combination of both. Double vision can affect just one eye (monocular) or both eyes (binocular). Treatments vary depending on the cause and type but include eye exercises, specially designed glasses, and surgery. Other than the obvious difficulties of navigating the world while viewing a double image, double vision can also cause disruptions in balance, movement and reading ability. There are a number of potential causes for double vision. As a result, the treatment depends on the particular patient. Some of the underlying causes are minor, others are serious.

For this reason, any instances of double vision should be checked by a doctor sooner rather than later. This article will take a look at the potential causes, diagnosis, and treatment of double vision. Fast facts on double vision (diplopia) Here are some key points about double vision (diplopia). More detail and supporting information is in the main article. Double vision can be caused by a number of underlying conditions Diplopia can affect just one eye or both A childhood squint can sometimes recur and cause double vision Temporary double vision can be caused by alcohol or other recreational drugs Treatments can include surgery, eye exercises, or corrective lenses Causes of binocular double vision Double vision can be caused by a number of conditions. Each eye creates its own image of the environment. These two representations are combined by the brain so that they are be perceived as one clear picture. If damage occurs to the muscles that move the eyes or the nerves that control that movement, a double image can be created. It is necessary for both eyes to be functioning together to create depth of field. Alternatively, the muscles moving the eyes can become weakened by certain illnesses and produce double vision. Squint In some cases, the eyes may not be properly aligned.

This condition is referred to as a squint or strabismus. Squints are relatively common in children but do not necessarily result in double vision. Squints cause the eyes to look in slightly different directions. This might be because the affected eye muscle(s): Are paralyzed or weak Are too strong Have abnormal nerves controlling them Sometimes, a squint can recur in people who had a squint as a child. In some cases, the treatment of a squint can actually cause double vision, despite the individual's vision being normal before the squint was treated. This is because the brain had been suppressing signals from one of the eyes in an attempt to maintain normal vision. Temporary double vision In some cases, double vision can be temporary. Temporary double vision is often caused by alcohol intoxication, benzodiazepines, opioids, or certain types of drugs for seizures and epilepsy . Head injuries, like concussions , can also cause temporary double vision. Being particularly tired or having strained eyes can bring on temporary double vision. If normal vision does not come back quickly, medical attention should be sought as soon as possible. Other causes of double vision Other than a squint, there are a number of potential conditions that can cause double vision.

These include: Certain thyroid problems can cause double vision. Thyroid: the thyroid gland is situated in the neck and produces a hormone called thyroxine. Changes in thyroid function can affect the external muscles that control the eye. This includes Grave's disease . Stroke or transient ischemic attack: blood vessels supplying the brain or nerves controlling the eye muscles can be affected. Aneurysm: an aneurysm is a bulge in a blood vessel. This can press on the nerve of the eye muscle. Convergence insufficiency : a condition where the eyes do not work together correctly. The cause is unknown, but it is thought to be due to the muscles that control the eye not lining up properly. Keratoconus : a degenerative condition of the eye that causes the cornea to thin and become cone-shaped. Diabetes: the blood vessels that supply blood to the retina at the back of the eye can be affected by diabetes . Myasthenia gravis: this condition can cause weakness in the body's muscles, including those controlling the eyes. Brain tumor/cancer: a tumor or growth behind the eye can interfere with free movement or damage the eye's nerves.

Multiple sclerosis: a disease that affects the central nervous system , including nerves that supply the eyes. Head injury: physically damaging the brain, nerves, muscles, or eye socket can restrict the movement of the eye and its muscles. Causes of monocular double vision If double vision is noted when one eye is covered and not when the other eye is covered, this is referred to as monocular double vision . Monocular double vision is less common than binocular double vision and can be caused by the following conditions: Astigmatism: the cornea is irregularly shaped (the transparent layer at the front of the eye). This causes a refractive error; in other words, the light is bent more, or less, than it should be. Dry eye: the eye does not produce enough tears, or it dries out too quickly Black eye: an injury can cause blood and fluid to collect around the eye. This can press on the eye itself or the muscles and nerves around it. Abnormality of the lens: for instance, cataracts , which are cloudy patches over the lens Abnormality of the retina: for example, macular degeneration , where the center of an individual's field of vision slowly disappears.

Diagnosing double vision Diagnosing double vision can be challenging for an ophthalmologist (eye specialist) because of the vast array of potential causes. An article on the American Academy of Ophthalmology 's website states the problem: "The patient who complains of double vision can have something as benign as dry eye or as life-threatening as an intracranial tumor. The cause may be as rare as Wernicke encephalopathy or as common as convergence insufficiency." Miriam Karmel The first question a specialist will ask to reduce the number of potential causes is whether the double vision is monocular or binocular. If the double vision is monocular, it means that the problem is more likely to be within the eye, rather than in the nerves and therefore less serious. Diagnosing double vision in children Because children cannot express what they are perceiving, diagnosing double vision in children can be more difficult.

Things to watch out for include: Squinting or narrowing the eyes to see Covering one eye with their hand Turning their head in an unusual way Looking at objects from the side rather than facing forward Flicking eyes side to side, between images Treatments for double vision The course of treatment for double vision depends on the underlying cause: Astigmatism Astigmatism refers to an abnormally curved cornea. In many cases, corrective lenses (glasses or contact lenses) can counteract the curvature and correct the passage of incoming light into the eye. Laser surgery is another option. This treatment involves reshaping the cornea with a laser. Cataracts Cataracts occur in more than half of Americans over the age of 80 and can sometimes cause double vision. In most cases, surgery is the best option. The surgical procedure removes the clouding and the cause of the double vision. Unfortunately, the operation itself can sometimes lead to double vision.

Treatments for binocular double vision Depending on the cause, the treatments for binocular vision vary, but they include: Wearing glasses Wearing an opaque contact lens Fixing thin, plastic, see-through prisms to glasses Botulinum toxin (Botox) injections into the eye muscles cause them to remain relaxed Wearing an eye patch Surgery on the muscles of the eye to correct their positioning Opaque intraocular lens Opaque intraocular lenses are an option for people with cataracts. They are only used once other methods to treat binocular double vision have failed. The procedure involves removing the lens of the eye and replacing it with an implant. Although the procedure is considered relatively safe, there are some associated risks. For instance, the intraocular lens can break up after it has been inserted. Dry eye syndrome If the eyes do not produce enough tears or dry out too quickly, the eyes can become inflamed and sore. This can result in double vision. Often, a prescription for tear substitute eye drops will clear up the condition. Only in very rare cases will surgery be needed.

Click the stars to rate this article Double Vision (Diplopia): Causes, Symptoms, and Treatments Public / Patient Deciphering Diplopia - American Academy of Ophthalmology Deciphering Diplopia Download PDF The symptom is diplopia. But what’s the diagnosis? When your patient sees two images, you may need to consider 20 possible causes, and ruling out 19 of those can be a headache. The various etiologies of diplopia comprise one of the most sweeping differential diagnoses in all of ophthalmology. The patient who complains of double vision can have something as benign as dry eye or as life-threatening as an intracranial tumor. The cause may be as rare as Wernicke encephalopathy or as common as convergence insufficiency. “It’s a huge differential diagnosis,” said Nurhan Torun, MD, director of the neuro-ophthalmology service at Beth Israel Deaconess Medical Center and an instructor of ophthalmology at Harvard Medical School in Boston. “Diplopia tends to be intimidating for many practitioners.” Intimidation may even turn to dread.

“When most ophthalmologists see a patient with a chief complaint of diplopia, they hate it,” said Michael S. Lee, MD, associate professor of ophthalmology, neurology and neurosurgery at the University of Minnesota in Minneapolis. “They often don’t know what to do with the patient.” What they do know, of course, is that the proper workup will take longer than a standard office visit. A multidisciplinary monster. Eric Eggenberger, DO, professor of neurology at Michigan State University in East Lansing, noted that diplopia challenges neurologists as well. “Ophthalmologists are not as comfortable with it as they are with vision loss because many of the diagnoses are neurologic. And neurologists are not comfortable with it because they’re not trained in techniques to measure ocular alignment.” But the consequences of a delayed or incorrect diagnosis are not comfortable, either. “Most double vision is not dangerous. But some is super dangerous,” said Andrew G. Lee, MD. “You have to do a complete and thorough exam to look for the distinctive dangerous sign. That sign could suggest a life-threatening diagnosis. It’s a red flag,” he said. Dr.

Lee is professor of ophthalmology, neurology and neurosurgery at Weill Cornell Medical College in New York as well as chairman of ophthalmology at The Methodist Hospital in Houston, adjunct professor of ophthalmology at the University of Iowa in Iowa City and clinical professor of ophthalmology at the University of Texas in Galveston. The exam of a diplopic patient demands a meticulous history and the posing of questions pertinent to the disposition of double images in various positions of gaze: Is the diplopia monocular or binocular? Are the images horizontal or vertical? Answers to these may determine whether the pathology is neurological or mechanical—involving a nerve, an extraocular muscle or a neuromuscular junction. Question: Monocular or Binocular? The first step in cornering diplopia is to determine whether it is monocular or binocular, said Karl C. Golnik, MD, professor of ophthalmology, neurology and neurosurgery at the University of Cincinnati. If it’s monocular, the patient sees double with only one eye open, and the extra image typically appears as a ghost, Dr. Golnik said.

Causes of this include media or refractive problems, dry eye, warped cornea, cataract, unstable tear film, IOL decentrations, media opacities, the wrong glasses and even uveitis. With binocular diplopia, however, the patient sees double only if both eyes are open. Cover either eye and the patient’s problem disappears—though the physician’s trouble may have just begun. Surprisingly, many doctors assume the diplopia is binocular, without considering monocular, though the differential diagnosis is different for each, Dr. Golnik said. In fact, he explains to referring colleagues that he does not need to see patients with monocular double vision because they typically don’t require a neurological evaluation. “Once you’ve determined it’s monocular, your level of anxiety goes down and your diagnostic techniques switch.” Dr. Michael Lee agreed. “It’s really reassuring if someone has monocular double vision,” he said, explaining that the cause must be within the eye itself. Binocular Dangers Binocular diplopia can be a cause for alarm. It may be a symptom of aneurysm, stroke, neoplasm, myasthenia gravis or trauma.

Even certain infections, such as sinus disease with a fungal infection, can present with double vision, especially in an immune-compromised patient. “There are literally hundreds of potential diagnoses,” Dr. Eggenberger said, and many of them are life-threatening. “Begin by localizing,” he said. “Once you’ve determined location you need to incorporate the patient’s age, demographics, history and other findings on exam to help with understanding the pathophysiology. This keeps you from jumping to conclusions.” Dr. Torun added that an assessment of ocular motility will help narrow things down. “That requires a very careful exam of the misalignment in different positions of gaze and looking for restriction of motility in any position of gaze,” she said. “Unless we make a correct diagnosis of the underlying eye movement problem, our differential is not going to be appropriate.” Dr. Golnik agreed. After the physician establishes binoc- ular diplopia, the next step is to figure out whether there’s a pattern to the misalignment. For example, he said, if it’s comitant—the double vision is the same no matter where the patient turns his head—the problem is less worrisome.

On the other hand, if it’s incomitant—the double vision goes away when the patient turns his head to the left but remains bad when turned right—then it’s time to worry. There are exceptions and nuances, but, said Dr. Golnik, “You can guide diagnostic evaluation better if you can find the pattern.” Five to Fear “There are clearly some life-threatening causes of double vision. Those are the ones an ophthalmologist can’t afford to miss,” Dr. Andrew Lee said. Following are five especially worrying possibilities. Dangerous Sign: Pupil involvement suggesting third-nerve palsy. Dangerous Diagnosis: Aneurysm. Dangerous Prognosis: “The one that’s going to kill you is the third-nerve palsy,” said Dr. Michael Lee, explaining it’s the most common presentation of an aneurysm of the posterior communicating artery. Dr. Golnik added that a third-nerve palsy with a large and poorly reactive pupil is a big red flag, and he doesn’t let the technician dilate the patient until he does the exam. Sometimes, however, the red flag turns out to be a false alarm.

While third-nerve palsy is a warning sign for aneurysm, it could also be associated with high blood pressure or diabetes. For example, Dr. Eggenberger said, an 85-year-old with high blood pressure, diabetes and normal pupils is probably not harboring a compressive lesion, but in a 25-year-old with pain and pupil involvement, the safer assumption would be that it’s compressive. As for those in-between cases, he said, “There’s no cookbook answer. It takes some time. It’s not a quick evaluation. And it’s very individualized. The challenge is in knowing which patient is going to get better in three months and which harbors a life-threatening diagnosis.” Dangerous Sign: Problem with more than one of the following: lid, pupil or eye movement. Dangerous Diagnosis: Horner syndrome (ptosis with small pupil), third-nerve palsy (ptosis with big pupil) or inflammatory disease, such as Guillain-Barré or Miller Fisher variant. Dangerous Prognosis: If any one of the lid, pupil or motility appears abnormal, you have to check the other two, said Dr. Andrew Lee.

“You’re not allowed to have more than one of these neuro-ophthalmic problems at a time.” More than one abnormality requires a referral or a more aggressive evaluation for the life-threatening etiologies, he said. The biggest dangers are aneurysmal third-nerve palsy and Horner syndrome from carotid dissection. Even mild third-nerve palsy could be due to aneurysm, which can kill the patient. Guillain-Barré also can cause death, or systemic paralysis. Dangerous Sign: More than one cranial nerve palsy. Dangerous Diagnosis: Multiple cranial neuropathy. Dangerous Prognosis: Intracranial or meningeal-based tumors, meningitis or polyneuropathy. Involvement of more than one nerve is a huge red flag, Dr. Andrew Lee said. Sixth-nerve involvement by itself in a diabetic patient probably indicates an ischemic mononeuropathy. Likewise, an isolated, complete and pupil-spared third nerve may indicate a benign and isolated ischemic palsy. But involvement of both the third and the sixth is dangerous and could be a cavernous sinus lesion. Dr.

Golnik remembers one patient referred to him with a diagnosis of unilateral sixth-nerve palsy who actually had metastatic lung cancer in the skull base. Dr. Golnik’s exam found involvement with the fifth and seventh nerves, something the referring physician might have found by checking facial sensation and facial muscle strength. Dangerous Sign: Weakness or fatigue, often variable. Dangerous Diagnosis: Myasthenia gravis. Dangerous Prognosis: Respiratory failure or aspiration. Myasthenia gravis can mimic almost any ophthalmoplegia and should be considered in the differential diagnosis of any pupil-spared motility disturbance, said Dr. Andrew Lee. “An ophthalmologist doesn’t have to be a neurologist but does have to ask the neurologic questions,” he said. Those include: Do you have other symptoms? Do you experience weakness in the arms or legs? Hoarseness? Difficulty swallowing? Dr. Torun described a patient who had transient diplopia and a presumed diagnosis of internuclear ophthalmoplegia. Multiple brain scans revealed nothing so the patient was referred to her. Initially, she agreed with the presumptive diagnosis. “But I also saw she had quite variable eye movements.

She had difficulty holding her eyes in an eccentric position, with the eyes drifting toward the center, which is a feature of myasthenia.” The workup for myasthenia was positive, and the patient was later admitted to the hospital in myasthenic crisis. The case illustrated the importance, Dr. Torun said, of early diagnosis of an ocular motility problem, which may be the initial presentation of a serious systemic disorder. Dangerous Sign: Onset of new kind of headache, scalp tenderness, pain with chewing. Dangerous Diagnosis: Giant cell arteritis. Dangerous Prognosis: GCA is a life- and sight-threatening disease that is associated with aortic dissection, cerebral and myocardial infarction. “Remember that giant cell arteritis can cause double vision, either constant or transient,” said Dr. Golnik, who asks every patient over the age of 50 a few giant-cell questions: Have you experienced a new kind of headache? Scalp tenderness? Pain or weakness with chewing? Unexplained weight loss?

Scans Don’t Think, Doctors Do Given the rigors of the diplopia differential diagnosis, it might be tempting to order a scan and let the machine figure it out. But in many situations, costly imaging may not catch a serious problem. For example, myasthenia gravis and giant cell arteritis aren’t apparent on imaging. Alternatively, imaging may indeed yield a life-saving diagnosis but only if the correct scan is aimed at the correct anatomy. Good scan, bad interpretation. CT scans of the orbit can rule out diplopia secondary to thyroid eye disease and orbital tumors, according to Dr. Golnik. “But beware the reportedly ‘normal’ MRI or CT scan when you are looking for an extraocular muscle abnormality,” he warned, because he routinely sees scans that are misread as normal. Pointless scan, pinhole better. What’s more, Dr. Golnik frequently sees patients with monocular diplopia who had had an MRI. “Thousands of dollars were spent, and all I needed was a pinhole test to tell it’s not a neurological problem,” he said. “If you just throw up the pinhole and the second image is gone, the patient can understand they don’t have a brain tumor.” Two bottom lines.

So when are scans warranted? “If it’s not neurologically isolated, you have to image,” Dr. Andrew Lee said. “For example, if you identify a sixth-nerve palsy, you have to also check the fifth and seventh nerves. If one of those is also affected, you have to image.” Age is a guide. In a patient under the age of 50, an image is advised unless there’s a long history of vasculopathic problems, Dr. Golnik said. Conversely, an isolated cranial nerve palsy in a patient over 50 who has high blood pressure and vascular risk factors but no other findings is probably not urgent, Dr. Golnik said. But he advised a six-week follow-up exam. “Hopefully they’ll start to improve. If not, then you need to image.” Transient Diplopia: Dr. Torun’s Differential Diagnosis Decompensated phoria Etiologies Overlooked Some causes of diplopia are easily missed, including: An extra hole in the iris from an iridotomy may cause diplopia, said Dr. Michael Lee.

Double vision may occur if the laser hole falls within the palpebral fissure rather than being hidden underneath the upper lid or if the prismatic effect of the tear meniscus allows light into a superiorly placed iridotomy. “I don’t think it’s something someone would normally think of,” he said. “When you talk about the major causes of monocular double vision, you think of refractive error, dry eye, warped cornea, cataract. The iridotomy is less common.” Thiamine deficiency can cause double vision, Dr. Torun said. Diplopia may be the earliest symptom of Wernicke encephalopathy, which consists of confusion and ataxia, along with ophthalmoplegia. The disease is typically associated with malnutrition and alcoholism, but it can also be seen in patients with gastric bypass procedures, as well as those with eating disorders—bulimia and anorexia. “These patients may have nystagmus or what mimics a sixth-nerve palsy. In severe cases, they may not be able to move their eyes at all,” Dr. Torun said. Untreated, the condition can lead to coma and eventually death.

If treated too late, it can cause neurological problems. But timely administration of intravenous thiamine (vitamin B1) may prevent permanent neurologic sequelae. Convergence spasm is a nonorganic cause of double vision, but it might easily be mistaken for a unilateral or bilateral sixth-nerve palsy or myasthenia, said Dr. Michael Lee. On first glance, the patient’s eyes are crossed and the complaint is double vision. But if the pupils are constricted, it’s likely the patient is deliberately crossing his eyes. “Miotic pupils, in a patient with variable esotropia and abduction deficits, can suggest convergence spasm,” Dr. Lee said. “When evaluating versions, there may be an abduction deficit and the pupils are miotic from convergence. When ductions are performed, the abduction deficit resolves.” He once saw a patient on referral who had undergone a few strabismus surgeries, but the diagnosis was convergence spasm. Skew deviation is a prenuclear vertical misalignment that results from brainstem or cerebellar lesions. It may be com- itant or incomitant, but a diagnostic feature is a marked decrease in the vertical misalignment with the patient in supine position.

Patients may give history of a stroke before onset of diplopia, said Dr. Torun. “If there are no associated brainstem signs and the misalignment is relatively small, it is easy to overlook, especially since motility is usually full.” An epiretinal membrane in one or both eyes can sometimes cause central binocular vertical diplopia, Dr. Torun said. Visual acuity could be quite good, though patients typically describe distortion on an Amsler grid. Motility is full. “This is easy to overlook if the maculopathy is subtle.” Meet the Experts Diplopia | Define Diplopia at Dictionary.com diplopia a pathological condition of vision in which a single object appears double (opposed to haplopia ). Expand 1805-15; < New Latin; see diplo- , -opia Related forms [dih-plop-ik, -ploh-pik] /dɪˈplɒp ɪk, -ˈploʊ pɪk/ (Show IPA), adjective Dictionary.com Unabridged Examples from the Web for diplopia Expand British Dictionary definitions for diplopia Expand noun 1.

a visual defect in which a single object is seen in duplicate; double vision. It can be caused by incorrect fixation or by an abnormality in the visual system Derived Forms Double Vision (Diplopia) and Ghost Images - AllAboutVision.com On this page: Double vision causes • Double vision treatment Double vision? If you start seeing double images when your eyes normally work well together, you should take it seriously. While double vision (also called diplopia) may be temporary, you should still visit your eye doctor to find out what's going on. Double Vision (Diplopia) Causes Temporary episodes of double vision can happen for many reasons, including drinking too much alcohol or being overly tired. This type of short-term double vision is usually not cause for worry. But if the diplopia is long-lasting or keeps coming back, reasons for it can include: Stroke, head injury, brain tumor, brain swelling or brain aneurysm. A head injury, tumor, stroke or related condition can cause double vision that comes on suddenly. After examining you, your eye doctor may refer you to a specialist such as a neurologist or neurosurgeon for further testing and treatment.

Ghost images and blurriness may mean you have diplopia. It's important to visit your eye doctor to find out why it's happening and what can be done about it. Corneal irregularities. Ghost images can be caused by such conditions as keratoconus (cone-shaped corneas) and corneal dystrophies (deterioration of the corneal structure). These ghost images can be harder to manage. Many corneal irregularities can be helped when you wear special contact lenses or use dry eye treatments such as eye drops or punctal plugs . Some people with this condition may need surgery, such as a corneal transplant or Intacs implants . Your eye doctor can help you figure out the best treatment for your individual problems. Dry eyes. Severe dry eyes, such as Sjogren's syndrome , can cause ghost images due to insufficient or poor quality tears. Many people who suffer from dry eyes can be helped by eye drops (over-the-counter or prescription), punctal plugs, eye vitamins , lid hygiene techniques or a combination of all these treatments.

It's very important to have a dry eye workup and treatment, if necessary, from an eye doctor who has an interest in this disorder and has kept up to date on the latest diagnosis and treatment methods. Refractive surgery. If you have had LASIK , PRK , or any refractive surgery to help you see better without glasses or contacts, you may experience some double or ghost imaging because of changes to your corneas . An irregular corneal surface, caused by the surgery itself or by dryness, may cause light rays to scatter instead of focusing properly. This problem usually clears up within weeks or months. But you may need to use eye drops for a while. In some cases, a second laser vision correction procedure might be necessary. What is more important than your vision? Find local eye doctor to get an eye exam Cataracts. Cataracts may cause ghost images, usually in one eye only. This is because the clouding of the eye's natural lens that sits behind the pupil can cause light rays to scatter in different directions, creating multiple but incomplete images, especially when you look at lights. Cataract surgery usually will eliminate this ghost image problem. Cranial nerve palsies.

Double vision also can be caused by paralysis or loss of coordination of one or more muscles that control the position and teaming of the eyes due to a cranial nerve palsy. Cranial nerve palsies can be caused by diabetes, head injury, tumor, multiple sclerosis, meningitis, high blood pressure, blockage in an artery or an aneurysm. Most cranial nerve palsies go away without treatment when the condition that caused them improves. But some people may need vision therapy , surgery or special prism in eyeglasses to help with the double vision. More About Ghost Images Rather than clearly seeing a double image, you may instead notice only a partial or "ghost image" around or to the side of what you are looking at, especially a light source. Ghost images, like those created by cataracts, usually are seen by only one eye. Ghost images can occur after corneal surgery, such as LASIK, PRK or a corneal transplant. Most of these problems disappear when the problem is resolved, like after cataract surgery or when the refractive surgery heals. More About Double Vision and Eye Structure Obviously, most of us don't expect to see double images.

But in truth, the ability to see a single image with two eyes involves a complex system of muscles, nerves and other eye parts. Antibiotics and Diplopia Fluoroquinolones May Be Linked to Double Vision Researchers analyzed 171 cases of double vision associated with systemic fluoroquinolones (antibiotics used for bronchitis, pneumonia, sinusitis and certain skin infections), occurring between 1986 and 2009. In 53 patients the antibiotics regimen was discontinued, and the double vision went away. One of the side effects of fluoroquinolones is tendon dysfunction, which if it occurs in muscles around the eyes, may cause double vision. A report on the study appeared in the September 2009 issue of Ophthalmology. When two eyes correctly and accurately point and focus at the same time, we see only one image of the world. When two eyes point and focus differently from each other, double vision may happen. Some people are born with eyes that don't work together, a condition called strabismus . Eyes can be crossed inward or turn outward. One eye can even go up while the other goes down.

If you have strabismus, you will see double if your brain allows it, because each eye sees a different thing at the same time. But the brain usually adapts by shutting down or ignoring the information from one eye. This is called suppression. Surgery or vision therapy can help many people with strabismus. Recommended For You Diplopia Treatment Generally, treatments for double vision can include surgery, vision therapy, prism in the glasses prescription or medications. Normal alignment: Esotropia (left eye): Exotropia (left eye): Double vision can occur when the eyes look in separate directions because of cranial nerve palsies, strabismus or other reasons. It's important to have a comprehensive eye exam to help determine the cause of the double vision as soon as possible. Your eye doctor may then treat the double vision or send you to a specialist (such as a neurologist or neurosurgeon). If you have sudden double vision that you ignore and then it goes away over a long time period, this may mean your brain has tuned out one of the images (suppressed it). Although this is certainly more comfortable and bearable for you, it is not a good sign.

Suppression could be masking a serious problem that needs to be solved. In fact, the condition may be a matter of life or death, such as a brain tumor or aneurysm. So see your eye doctor immediately if double vision develops. Some conditions causing double vision are difficult, if not impossible, to fix. Some strokes and nerve palsies cause fluctuating double vision that can't be measured accurately enough to correct. In these circumstances, you may need a period of adjustment so that you can learn to live with the symptoms. Your eye doctor can help by prescribing prism, patching one eye for periods of time, fogging parts of your glasses lenses or using special contact lenses. In most cases, your brain will eventually suppress one of the images so you can get on with your life. As with most life changes, patience is a virtue in dealing with such problems! Home » Conditions » Double Vision / Diplopia [Page updated May 2015] Like This Page? Please Share! Recommended For You

Question: Diplopia is the medical term for what problem?
Answer: Double Vision